Disablement

There is yet a further advantage in considering morbidity as a continuum in a population. Morbidity refers to symptoms, syndromes, or disorders. But there is a universe of discourse closely linked to this, namely disablement. This is the collective noun now used to refer to the impairment, disability, and social role handicap in daily life that disorders bring with them. It is self-evident that the main categories of mental disorder, especially the psychoses, affective disorders, and dementias, are almost always associated with substantial disablement. But subclinical levels of mental disorders also carry with them a certain amount of disablement. From the point of view of a whole population, the amount of disablement from subclinical or milder conditions is cumulatively substantial. This is because such conditions have a high point prevalence. Therefore, from a public health perspective, the significance of milder mental disorders is not trivial because of the disablement they bring in daily life. Disablement has recently come to carry new significance in the interpretation of prevalence estimates from large community surveys. These typically produce 12-month prevalence rates of 15 per cent or more for all types of mental disorder taken together. But it is most unlikely that 15 per cent of the population require professional treatment. Only a proportion of the 15 per cent may find their symptoms disabling. The interpretation and administrative significance of prevalence estimates are therefore likely to command much more attention in the future. This is necessary if such epidemiological information is to inform us about the burden of mental disorders in the community/2,6,2,28>

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